FoodShare Forms

Clicking the Assigned Number link will either download the selected form (if only one version is available) OR it will open a page that will display all language versions of that form. From that page you can choose and download the needed forms.
Assigned Number Title Division Other Location
F-16019A FoodShare Wisconsin Registration DMS
F-16019B FoodShare Wisconsin Registration Packet DMS
F-16015 Notice of Approval of Benefits/Positive Change in Benefits DMS
F-16039 Waiver of Administrative Disqualification Hearing DMS
F-10126 Appoint, Change, or Remove an Authorized Representative DMS
F-01891 New Employment Reporting – FoodShare Employment and Training (FSET) Program DMS
F-16001 Notice of Denial of Benefits/Negative Change in Benefits DMS
F-16024 FoodShare Notice of Disqualification DMS
F-16004 Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits DMS
F-16066 FoodShare Wisconsin Income Change Report DMS
F-16025 Disqualification Consent Agreement DMS
F-02340 Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement DMS
F-16026 Prosecution Diversion Agreement DMS
F-19002 Request to Reduce QUEST Card Balance DMS
F-16038 Administrative Disqualification Hearing Notice DMS
F-16028 Notice of FoodShare Overissuance DMS
F-10150 Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare DMS
F-10150B Your Rights and Responsibilities for FoodShare DMS
F-00136 FoodShare Employment and Training (FSET) Program Participation Agreement DMS
F-00330 Request for Replacement FoodShare Benefits DMS
F-10146 Employer Verification of Earnings DMS
F-01359 Historical Earnings Verification Request DMS
F-81020E Confidentiality and Non-Disclosure Acknowledgement: Volunteer (Food Pantry) DMS
F-16076 FoodShare Six-Month Report and Instructions DMS
F-16030 FoodShare Wisconsin Under / Overissuance Worksheet and Overpayment Calculator DMS
F-16033 FoodShare Worksheet DMS
F-00219 Self-Employment Income Report: Farm Business DMS
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application DMS
F-16029 FoodShare Wisconsin Repayment Agreement DMS
F-00107 Self-Employment Income Report DMS
F-10144 Wisconsin Life Insurance Inquiry DMS
F-01985 Self-Employment Income Worksheet: Personal Capital Gains or Losses (Schedule D) DMS
F-16035 Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) DMS
F-16036 Self-Employment Income Worksheet: Partnership (Schedule K-1 [Form 1065] and Form 1065) DMS
F-00628 Consortium Response to the State IM Second Party Review Finding DMS
F-00098 Summary of Information Letter DMS
F-16073 FoodShare Wisconsin Nonfinancial Worksheet DMS
F-16104 Local Agency Customer Feedback DMS
F-16023 Striker Evaluation DMS
F-16011 Quality Assurance (QA) Sample Checklist DMS
F-16022 Social Security Number Referral DMS
F-10140 Wisconsin Medicaid Supplement to FoodShare Wisconsin Application DMS
F-01598 Medical Exemption from Work Requirement for Able-Bodied Adults Without Dependents DMS
F-16050 Agency Position on the State Quality Control (QC) Finding DMS
F-01252 FoodShare Employment and Training (FSET) - Initial Appointment DMS
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice DMS
F-01254 FoodShare Employment and Training (FSET) - Employment Plan (EP) Appointment DMS
F-01255 FoodShare Employment and Training (FSET) - Job Club Appointment DMS
F-01256 FoodShare Employment and Training (FSET) - Discuss FSET Participation DMS
F-01257 FoodShare Employment and Training (FSET) - Workshop Appointment DMS
Last Revised: April 11, 2018